tango

Lead and oversee claims and encounter operations, driving process improvements, system optimization, and compliance. | Extensive healthcare claims operations experience, strong system and automation expertise, leadership skills, and familiarity with claims adjudication and system platforms. | tango is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care. We are currently looking for a Director, Claims and Encounter Operations to join our growing team! Position Description: Provides strategic leadership and oversight to claims and encounter operations, driving process innovation, system optimization, regulatory compliance, and cross-functional program delivery. This role is accountable for ensuring technical integrity, efficiency, and compliance of all claims and encounter operations while fostering a high-performing, results-driven culture. Office Location: • * Remote ** Responsibilities include, but are not limited to the following: • Ensure integrations are functioning optimally; recommend and implement enhancements to improve departmental efficiency and effectiveness. • Identify, propose, and embed business rules and operational best practices that advance claims processing performance. • Oversee claims vendor relationships and maintenance activities to uphold quality and compliance standards. • Lead configuration and testing of plan benefits and claims within the claims system, ensuring system design aligns with business goals and compliance requirements. • Serve as the business lead for process improvements and system alignment. • Deliver solutions that elevate claims workflows and support organizational efficiency through cross-departmental collaboration. • Oversee quality management and provide technical direction to ensure compliance with internal and external policies across all claims and encounter operations. • Define, monitor, and measure operational effectiveness; analyze data to identify opportunities for improvement. • Respond to and remediate operational issues in partnership with other business units and vendor partners. • Collaborate with organizational leaders to achieve strategic objectives and drive organizational vision. • Maintain direct accountability for all functional and technical aspects of claims processing. • Foster a results-driven, compliant, and high-performing culture across the claims teams. • Lead reviews and resolution efforts for auto-adjudication inhibitors, leveraging process automation and system tool advancements. • Oversee technical processes for adjustments and reprocessing using automated system tools. Qualifications: • Bachelor's degree required (advanced degree preferred) • 8+ years in healthcare claims operations, including 5+ years in a leadership capacity • Deep expertise in systems configuration, claims adjudication, process automation, operational compliance, and cross-functional program management • Advanced knowledge of EDI, COB, auto-adjudication rules, and claims system platforms • Proven ability to manage complex technical implementations and drive organizational change • Strong analytical, strategic thinking, and communication skills across all organizational levels Proven Personal Attributes: • Strategic thinker with ability to balance operational excellence with innovation • Strong leadership presence and ability to build and motivate high-performing teams • Results-oriented with proven track record of delivering measurable improvements • Detail-oriented with strong organizational and project management skills • Excellent communication and stakeholder management abilities • Self-motivated, proactive problem-solver with strong work ethic • Commitment to continuous learning and process improvement tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

Lead a team managing provider relations and value-based care performance to improve quality and cost-effectiveness in home health services. | Bachelor's degree, 5-7 years in provider relations or value-based care, 2+ years leadership, strong healthcare knowledge, and project management skills. | Brief Description • Position is remote, however you must live in MST of PST time zone to be considered for this opportunity** Position Summary tango is a delegated entity that partners with health plans to manage the full spectrum of home health services for their members. We are seeking a Manager of Provider Relations and Value Based Performance to lead a team dedicated to strengthening provider partnerships and improving performance within value based arrangements. This leadership role plays a critical part in ensuring that our network of home health providers delivers high-quality, cost-effective care. Key Responsibilities Leadership & Team Management: • Lead, coach, and mentor a team of provider relations specialists. • Set team goals and performance standards in alignment with tango’s strategic objectives and health plan expectations. • Foster a culture of accountability, collaboration, and provider-centric service. Provider Relations & Network Engagement • Serve as the primary escalation point for provider concerns, performance issues, and network questions. • Build and maintain strong, trust-based relationships with home health agencies and partner providers. • Communicate program updates, expectations, and performance metrics to ensure network alignment. Value-Based Care Performance Oversight • Monitor provider performance under delegated value based care arrangements, focusing on quality, utilization, and patient outcomes. • Collaborate with internal analytics, clinical, and operations teams to identify trends, gaps, and opportunities for improvement. • Drive provider engagement in performance improvement initiatives to meet shared savings and quality targets. Strategic & Operational Support • Translate tango strategy into operational tactics to support provider engagement and performance. • Assist in optimizing tango’s value-based care frameworks and incentive models by providing insights from the field. Qualifications Education & Experience: • Bachelor’s degree in healthcare administration, business, public health, or a related field required. • 5–7 years of progressive experience in provider relations, network management, and value-based care, preferably in a delegated or managed care environment. • 2+ years of direct people leadership experience. Knowledge, Skills, & Abilities • Strong understanding of delegated health plan-provider relationships and value based care models, especially in home health or post-acute care. • Proven ability to interpret performance data and lead successful provider performance initiatives. • Exceptional interpersonal, communication, and negotiation skills. • Strong project management skills with the ability to manage multiple priorities in a fast-paced, evolving environment. Work Environment • Remote, with periodic travel to provider sites and internal meetings as needed. • Must be comfortable working across multiple health plan partners and adapting to varying delegation requirements. tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.